Timo Reunala's research while affiliated with Tampere University and other places

Publications (384)

Article
Background Celiac disease has been associated with increased mortality, but data on long-term mortality are scarce. Aims To determine long-term mortality in celiac disease. Methods The study cohort consisted of all celiac disease patients (n=1,392) diagnosed in Tampere University Hospital catchment area 1960 – 2000. Patients were categorized into...
Article
Dermatitis herpetiformis is a blistering autoimmune skin disease, and a cutaneous manifestation of coeliac disease. The burden of coeliac disease is increased especially in females, but studies concerning sex differences in patients with long-term treated dermatitis herpetiformis are scarce. This questionnaire study compared adherence to a gluten-f...
Chapter
Dermatitis herpetiformis (DH), presenting with an intense itch and blistering symmetrical rash, typically on the elbows, knees, and buttocks, is a cutaneous manifestation of coeliac disease. Overt gastrointestinal symptoms are rare though most patients have villous atrophy in the small bowel, and the rest coeliac-type inflammatory changes. In contr...
Article
Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease. Dermatitis herpetiformis is treated with a gluten-free diet. However, the itching and blistering rash alleviates slowly after gluten withdrawal and occasionally persists despite a long-term gluten-free diet. This study investigated the prevalence and factors associated with p...
Article
Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease. Anaemia is a common finding in patients with untreated coeliac disease, but little is known about the occurrence of anaemia in those with dermatitis herpetiformis. This study investigated the prevalence of anaemia and factors associated with anaemia in 250 patients with derma...
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Background The increased risk of malignancies in coeliac disease is well recognised, but data on incidence and predisposing factors are scarce. Our aim was to determine cancer incidence and its prognostic factors in coeliac disease during a long‐term follow‐up. Methods The study cohort comprised all (n=1460) coeliac patients diagnosed in Tampere U...
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Full-text available
Dermatitis herpetiformis (DH), presenting with an intense itch and blistering symmetrical rash, typically on the elbows, knees, and buttocks, is a cutaneous manifestation of celiac disease. Though overt gastrointestinal symptoms are rare, three-fourths of patients with DH have villous atrophy in the small bowel, and the rest have celiac-type inflam...
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Dermatitis herpetiformis (DH) is an extraintestinal manifestation of gluten sensitivity, in which an autoimmune response is directed against transglutaminase 3 (TG3), an epidermal transglutaminase. TG2 is the autoantigen in celiac disease (CD), defined by the presence of enteropathy, and TG6 is the autoantigen in neurological manifestations of glut...
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Serology for anti‐epidermal transglutaminase antibodies (Anti‐TG3 Abs) has attracted interest, being inexpensive and non‐invasive and could ideally replace skin biopsy for the diagnosis of Dermatitis Herpetiformis (DH)1. The current commercially available ELISA (Elisa Kit) for serum Anti‐TG3 Abs overall has a good specificity (84‐100%)2‐4 however,...
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The treatment of choice for dermatitis herpetiformis (DH), a cutaneous manifestation of coeliac disease, is a life-long gluten-free diet (GFD). In a GFD, wheat, rye and barley should be strictly avoided, but the role of oats is more controversial. This study aimed to investigate the safety and long-term quality of life and health effects of oat con...
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Dermatitis herpetiformis (DH), a cutaneous manifestation of coeliac disease, is characterized by transglutaminase (TG) 3-targeted dermal immunoglobulin A (IgA) deposits. The treatment for DH is the same as for coeliac disease, namely a life-long gluten-free diet. DH patients typically have gluten-dependent circulating autoantibodies targeting TG3 a...
Article
Objectives: Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Bone fracture risk is increased in coeliac disease, but little knowledge exists about bone complications in DH. This study aimed to evaluate the risk of hip and other hospital-treated fractures in DH and coeliac disease in a high prevalence area with good adh...
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Full-text available
Dermatitis herpetiformis (DH) is an extraintestinal manifestation of celiac disease causing an itchy, blistering rash. Granular IgA deposits in the skin are pathognomonic for DH, and the treatment of choice is a lifelong gluten-free diet (GFD). Preliminary evidence suggests that there are patients with DH who redevelop gluten tolerance after adhere...
Article
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Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. At diagnosis, the majority of patients have villous atrophy in the small bowel mucosa. The objective of this study was to investigate whether the presence or absence of villous atrophy at diagnosis affects the long-term prognosis of DH. Data were gathered from the patien...
Article
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Dermatitis herpetiformis (DH) is a common extraintestinal manifestation of coeliac disease presenting with itchy papules and vesicles on the elbows, knees, and buttocks. Overt gastrointestinal symptoms are rare. Diagnosis of DH is easily confirmed by immunofluorescence biopsy showing pathognomonic granular immunoglobulin A (IgA) deposits in the pap...
Article
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Dermatitis herpetiformis (DH) is a cutaneous manifestation of coeliac disease. Increased bone fracture risk is known to associate with coeliac disease, but this has been only scantly studied in DH. In this study, self-reported fractures and fracture-associated factors in DH were investigated and compared to coeliac disease. Altogether, 222 DH patie...
Article
Coeliac disease and dermatitis herpetiformis (DH) are characterized by autoantibodies targeting transglutaminase (TG)2 and TG3, respectively. Previous studies show that TG2 antibodies are produced in the gut and can be assessed in organ culture of small-intestinal biopsies from patients with coeliac disease. Thus far, no studies have investigated T...
Article
Dermatitis herpetiformis (DH) is an extra-intestinal manifestation of coeliac disease. The highest currently reported prevalence of DH is in Finland, but knowledge of diagnostic delay is limited. This study investigated the duration of rash prior to diagnosis in 446 patients with DH, analysing the results in 3 periods of 15 years. The diagnosis was...
Article
Full-text available
Dermatitis herpetiformis (DH) is an itchy, blistering skin disease characterised by the deposition of granular immunoglobulin A (IgA) in the papillary dermis. It is regarded as the cutaneous manifestation of coeliac disease, an autoimmune-mediated condition affecting the small intestine. In addition to skin symptoms, DH patients have mostly subclin...
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Humans obtain vitamin D from conversion of 7-dehydrocholesterol in the skin by ultraviolet B (UVB) radiation or from dietary sources. As the radiation level is insufficient in winter, vitamin D deficiency is common at higher latitudes. We assessed whether vernal solar UVB radiation at latitudes 61°N and 67°N in Finland has an impact on serum 25-hyd...
Article
Dermatitis herpetiformis (DH) is an itchy blistering skin disease with predilection sites on elbows, knees, and buttocks. Diagnosis is confirmed by showing granular immunoglobulin A deposits in perilesional skin. DH is one manifestation of coeliac disease; the skin symptoms heal with gluten free diet (GFD) and relapse on gluten challenge. Of the fi...
Article
Psoriasis and atopic dermatitis (AD) have a negative impact on patients’ health-related quality of life (HRQoL) (1, 2). There is a long tradition of heliotherapy (HT) in the Canary Islands for the treatment of Finnish patients with psoriasis and AD (3, 4), and the courses have recently been updated to include more empowering elements. The present m...
Article
Dermatitis herpetiformis (DH) is an extraintestinal manifestation of coeliac disease. The burden of illness in untreated coeliac disease is known to be considerable, but corresponding evidence for DH is lacking. In this study the burden of DH was evaluated prospectively in 52 patients newly diagnosed with DH using a study questionnaire and a valida...
Article
Goals: We analyzed from our prospectively collected series of patients with dermatitis herpetiformis (DH) whether small-bowel histologic findings are changing and how serum tissue transglutaminase (TG2) IgA antibodies correlate to mucosal damage. Background: DH is an extraintestinal manifestation of celiac disease presenting with itchy blisterin...
Article
Background: Transglutaminase (TG)2 is the autoantigen in celiac disease, but also TG3 antibodies have been detected in the serum of celiac disease patients. Aims: To investigate the correlations between serum TG3 antibodies and clinical and histological manifestations of celiac disease and to assess gluten-dependency of TG3 antibodies. Methods:...
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Exposure to solar ultraviolet B radiation during the summer months is the main source of vitamin D (VD) for people living in northern latitudes. The aim of this study was to determine whether artificial narrowband ultraviolet B (NB-UVB) whole-body exposures could maintain VD levels in winter. The intervention group received 2 standard erythema dose...
Article
Dermatitis herpetiformis (DH) is a cutaneous manifestation of celiac disease. Both conditions are treated with a restrictive life-long gluten-free diet (GFD). Treated celiac disease patients have been shown to have more severe gastrointestinal symptoms and inferior quality of life compared with healthy controls, but evidence regarding quality of li...
Article
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Dermatitis herpetiformis (DH) is a blistering skin disease, which is regarded as an extra-intestinal manifestation of coeliac disease. Refractory cases of coeliac disease, that do not respond to a gluten-free diet and which carry a high risk of lymphoma, are well-known in coeliac disease. To determine whether refractory cases of DH with active rash...
Article
Dermatitis herpetiformis (DH) is an itchy, blistering skin disease with sites of predilection at the elbows, knees and buttocks. Although DH is mostly asymptomatic, all patients exhibit small bowel villous atrophy or coeliac-type inflammatory granular immunoglobulin changes. Deposition of immunoglobulin A (IgA) in the papillary dermis is a key diag...
Article
Objective: Dermatitis herpetiformis (DH) is a cutaneous form of celiac disease affecting ∼ 17% of celiac disease patients. The aim was to determine how often celiac disease precedes the development of DH, and what is the impact of gluten-free diet (GFD) in this phenotype change. Material and methods: Our prospectively collected DH series from 19...
Article
Empowering heliotherapy aims at clinical healing and improved coping with psoriasis and atopic dermatitis, but evidence of long-term effects is scarce. We studied the effect of 2-week empowering heliotherapy in the Canary Islands on clinical outcome and quality of life in 22 psoriasis and 13 atopic dermatitis patients. Using the self-administered P...
Article
Dermatitis herpetiformis (DH) is an intensively itching blistering skin disease, which is currently recognized as an extra-intestinal manifestation of coeliac disease. The majority of DH patients have subclinical villous atrophy in the small bowel identical to coeliac disease, and the remainder show signs of mucosal inflammation. The small bowel mu...
Article
Dermatitis herpetiformis (DH) is an itching, blistering skin disease presenting with typical rash on the elbows, knees and buttocks. Diagnosis is confirmed by demonstration of granular IgA deposits in the papillary dermis by direct immunofluorescence. The majority of the patients with DH have coeliac-type enteropathy in the small intestine and also...
Article
Dermatitis herpetiformis (DH) is an extraintestinal manifestation of coeliac disease. Untreated coeliac disease patients are known to have transglutaminase 2 (TG2)-targeted IgA deposits in the small bowel mucosa. To evaluate whether similar intestinal IgA deposits are also present in DH and whether the deposits disappear with gluten-free diet, 47 u...
Article
Background/aims: Chronic kidney disease (CKD) patients on dialysis are prone to vitamin D insufficiency despite oral vitamin D supplementation. Here, we studied whether narrow-band ultraviolet B (NB-UVB) exposures improve vitamin D balance. Methods: 14 haemodialysis patients and 15 healthy subjects receiving oral cholecalciferol 20 µg daily got...
Article
A course of treatment with narrow-band ultraviolet B (NB-UVB) improves psoriasis and increases serum 25-hydroxyvitamin D (25(OH)D). In this study 12 patients with psoriasis who were supplemented with oral cholecalciferol, 20 µg daily, were given a course of NB-UVB and their response measured. At baseline, serum 25(OH)D was 74.14 ± 22.9 nmol/l. At t...
Article
Background: Dermatitis herpetiformis (DH) is an extra-intestinal manifestation of coeliac disease and most patients adhere to a life-long gluten free diet (GFD). Increased mortality rates have been reported in coeliac disease but knowledge in DH is scanty. Objectives: To survey the mortality rate and causes of death in a large cohort of patients...
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People frequently experience wealing and delayed papules from mosquito bites. Wealing is mediated by antisaliva IgE antibodies and histamine. Rupatadine is a new antihistamine effective in allergic rhinitis and urticaria, but the effect on mosquito-bite allergy is not known. To determine the effectiveness of rupatadine in inmediate mosquito-bite al...
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Previous small studies suggest that chronic atrophic gastritis is common in dermatitis herpetiformis (DH). We here examined the frequency and topography of chronic gastritis in 93 untreated DH subjects and in 186 controls with dyspepsia. Specimens were drawn from the gastric corpus and antrum and examined for atrophy, intestinal metaplasia, and Hel...
Article
A short course of narrowband ultraviolet B (NB-UVB) exposures increases the serum 25-hydroxyvitamin D [25(OH)D] concentration in patients with psoriasis and healthy subjects. To compare the effects of NB-UVB and oral vitamin D substitution in healthy subjects in winter. Healthy adult hospital employees and medical students were screened for serum 2...
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In the acute phase of atopic dermatitis (AD), T-helper type 2 (Th2) cytokines characterize the inflammatory response in the skin. IL-33 is a new tissue-derived cytokine, which is mainly expressed by cells of barrier tissues, and is known to activate Th2 lymphocytes, mast cells, and eosinophils. IL-33 signals through a receptor complex consisting of...
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Chronic kidney disease (CKD) patients are especially prone to vitamin D insufficiency. Narrow-band ultraviolet B (NB-UVB) treatment increases serum 25-hydroxyvitamin D [25(OH)D] in dermatological patients, and we studied whether it also improves vitamin D balance in CKD patients on haemodialysis. Fifteen dialysis patients (mean age 48.3 years) and...
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Asthma and other allergic diseases are continuously increasing, causing considerable economic and sociologic burden to society. The hygiene hypothesis proposes that lack of microbial T helper (Th) 1-like stimulation during early childhood leads to increased Th2-driven allergic disorders later in life. Immunostimulatory cytosine-phosphate-guanosine...
Article
Dermatitis herpetiformis (DH) is an external manifestation of coeliac disease presenting with blistering rash and pathognomonic cutaneous IgA deposits. Better knowledge of subclinical forms and serological testing has resulted in a sharp increase in the incidence and prevalence of coeliac disease. To investigate the prevalence of DH and analyse whe...
Article
BACKGROund: Patient-oriented medicine is an emerging concept, encouraged by the World Health Organization, to greater involvement of the patient in the management of chronic diseases. The Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) index is a self-assessment score allowing the patient to comprehensively evaluate the actual course of atop...
Article
The objective of the study was to compare Bacillus subtilis spore film dosimeters with a Robertson Berger UV meter (RB meter) and diary records for assessing personal UV-B doses during a 13-day heliotherapy (HT) for atopic dermatitis (AD). In addition, the relationship between the personal UV-B dose and change in serum 25-hydroxyvitamin D (25(OH)D)...
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Background Vitamin D insufficiency is common in winter in the Nordic countries. Objectives To examine whether a short course of narrowband ultraviolet B (NB-UVB) improves vitamin D balance. Methods Fifty-six healthy, white women (mean age 41 years) volunteered and 53 completed the study. NB-UVB exposures were given on seven consecutive days either...
Article
Narrowband ultraviolet B (NB-UVB) is a routine treatment for psoriasis and atopic dermatitis (AD) but its effect on vitamin D balance is not well studied. To examine whether NB-UVB treatment in winter improves vitamin D balance in psoriasis and AD, and to study the effects of NB-UVB on antimicrobial peptide and cytokine expression in the skin. Eigh...
Article
Recognition of common sexually transmitted infection (STI) syndromes allows more efficient diagnosis and treatment. These evidence-based guidelines provide advice on the management of STIs, including the use of the appropriate diagnostic methods and therapeutic regimens. Early and appropriate therapy has the potential to significantly reduce the lo...
Article
The two clinical phenotypes of gluten enteropathy, coeliac disease (CD) and dermatitis herpetiformis (DH), were characterized for numbers and homing profiles of circulating final effector B cells, plasmablasts, identified as immunoglobulin (Ig)-secreting cells (ISC). In CD, the numbers of ISC were approximately 50% lower than in DH or controls. ISC...
Article
Coeliac disease diagnostic criteria currently require the detection of small bowel mucosal villous atrophy and crypt hyperplasia. To compare conventional histological examination to the determination of small bowel mucosal intraepithelial lymphocytes (IELs) and to serum and intestinal coeliac autoantibodies in untreated coeliac disease with villous...
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The deer ked (Lipoptena cervi) is a haematophagous ectoparasite of moose (Alces alces) and other cervids that commonly bites humans in Finland. Since the 1970s there has been an increasing number of Finns who suffer from long-lasting and recurrent dermatitis associated with deer ked bites. Forestry workers, hunters, berry and mushroom pickers, and...
Article
Celiac disease is an autoimmune disorder wherein the ingestion of gluten causes villous atrophy of the small intestinal mucosa with crypt hyperplasia in genetically susceptible individuals. The classic symptoms are malabsorption, steatorrhea, weight loss, growth retardation, and failure to thrive (1,2). Dermatitis herpetiformis is a well-known extr...
Article
Finnish children with atopic dermatitis (AD) are frequently sensitized and show positive food challenge to turnip rape. We examined whether French children are also allergic to this oilseed plant and whether mustard could be the cross-reacting allergen. Turnip rape and mustard challenge was performed to 14 Finnish and 14 French children with atopic...
Article
Background Vitamin D insufficiency during winter is common in the Nordic countries. Heliotherapy (HT) may heal atopic dermatitis (AD) but its effect on vitamin D balance has not been examined. Objectives To study the effect of HT on serum calcidiol (25-hydroxyvitamin D) concentration and on healing of AD. Methods Twenty-three adult patients with AD...
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Pimecrolimus cream 1% has been shown to effectively control atopic eczema (AE) when applied twice daily from the first signs or symptoms of AE until clearance. Moreover, pimecrolimus cream 1% has a favourable safety profile, lacking topical corticosteroid-related side-effects such as skin atrophy, making it particularly useful to treat delicate bod...
Article
Turnip rape and oilseed rape 2S albumins are new allergens in children with atopic dermatitis suspected for food allergy. We recently found that 11% (206/1887) of these children had a positive skin prick test to seeds of oilseed rape (Brassica napus) and/or turnip rape (Brassica rapa). In the present case-control study we examined how the children...
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Hirvikärpäsihottuma – maanlaajuinen riesa Hirvikärpänen on 50 vuoden aikana levin-nyt kaakosta yli Etelä-ja Keski-Suomen. Sen pääisäntäeläin on hirvi, jonka ihosta se imee verta ja jonka turkissa se lisääntyy. Hirvikärpäset ovat myös ihmiselle riesak-si, sillä ne aiheuttavat kiusallista voimak-kaasti kutiavaa ja jopa kuukausia kestävää ihottumaa. T...
Article
Many patients with moderate-to-severe plaque psoriasis do not respond adequately to methotrexate monotherapy. This pilot study, with a small patient population, was performed to evaluate the effectiveness and safety of etanercept and methotrexate combination in patients with plaque psoriasis and inadequate response to methotrexate. Outpatients with...
Article
Hevea brasiliensis (Hev b) 2 and Hev b 13 have recently been identified as major latex allergens by detecting specific IgE antibodies in >50% of sera from Hev b latex-allergic individuals. We assessed the prevalence rates for sensitization to extensively purified latex allergens in patients from three diverse geographical areas. Native Hev b 2, Hev...
Article
Assessment of allergenic potential of medical devices made of natural rubber latex (NRL) requires the measurement of concentrations of specific allergenic proteins or polypeptides eluting from rubber. Four NRL allergens (Hev b 1, 3, 5, and 6.02) were quantified in all medical glove brands marketed in Finland in 1999, 2001, and 2003 (n = 208) by a c...
Article
Basophil histamine release and lymphocyte proliferation tests were examined with latex allergen prepared from surgical gloves in 15 patients with latex contact urticaria. The basophil histamine release test (BHRT) yielded positive results in 13/14 (93%) patients, whereas commercial latex RAST was positive in only 9/15 (60%) patients. Lymphocyte pro...